Using Hospitalization Data To Estimate The Public Health Burden of Coccidioidomycosis in California V. Flaherman, R. Hector, G. Rutherford University of California, San Francisco

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Using Hospitalization Data To Estimate The
Public Health Burden of Coccidioidomycosis in
CaliforniaV. Flaherman, R. Hector, G.
RutherfordUniversity of California, San Francisco
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Descriptive epidemiology

• U.S. population at risk 30 million, including
  central and southern California and most of
  Arizona, parts of NM, TX, UT, NV
• Mexican population at risk 14 millions,
  including most of BC, BCS, CO, CH, NL, SO
• Estimated 150,000 new infections in US annually,
  50,000 cases of primary disease (7,000 reported),
  3,500 cases of disseminated disease and 200
  deaths per year

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Coccidioidomycosis, United States, 2002

• 4,984 cases reported
• Rates increase with increasing age
• Rates in males (3.65 per 100,000) higher than
  females (2.63 per 100,000)
• 97 of cases reported from California and Arizona

Rate per 100,000 by age group
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Costs of hospitalizations for coccidioidomycosis,
Arizona, 1998-2001

• 598 (11.8 per 100,000) patients hospitalized in
  Arizona in 2001
• 34 65 years old
• 26 had disseminated disease
• 10 had meningitis
• Direct hospital charges were 19,342,776 in 2001
• Hospital charges for the 1998-2001 period were
  33,762 per hospitalized patient

Park BJ, Sigel K, Vaz V, et al. An epidemic of
coccidioidomycosis in Arizona associated with
climate changes, 1998-2001. J Infect Dis 2005
1911981-7.
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Sources of Data for California Study

• Inpatient Hospital Discharge Data Set, California
  Office of Statewide Health Planning and
  Development
• Data from all non-federal hospitals in California
• Abstracted all discharge records with ICD codes
  for coccidioidomycosis (ICD-9 codes 114.0-114.5,
  114.9)
• Each record treated as discrete hospitalization
• Extracted years of admission, residence, age,
  race/ethnicity, sex, HIV status, vital status at
  discharge
• California population estimates from Dept. of
  Finance
• County residence, age, race/ethnicity, sex, HIV
  population

Flaherman VJ, Hector R, Rutherford GW.
Coccidioidomycosis in California Estimating
burden of severe disease using hospital discharge
data. EID 131087 (2007)
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Hospitalizations for Coccidioidomycosis
California, 1997-2002

• 7,457 hospitalizations for coccidioidomycosis
• Average 1,258 per year
• Incidence 3.7 per 100,000 per year
• 2.4 per 100,000 after adjustment for
  rehospitalization (37)
• 72 had principal or first additional diagnosis
  of coccidioidomycosis 12 as second additional
  diagnosis
• 417 discharged dead from hospital
• Average 70 per year
• 8.9 of persons initially hospitalized with
  coccidioidomycosis had fatal outcome

Flaherman VJ, Hector R, Rutherford GW.
Coccidioidomycosis in California Estimating
burden of severe disease using hospital discharge
data. EID 131087 (2007)
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Hospital discharges with diagnosis of
coccidioidomycosis, California, 1997-2003
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Coccidioidomycosis hospitalizations by county,
1997-2002
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Incidence of hospitalized coccidioidomycosis by
county, California, 1997-2002
County Cases Incidence per 100,000
Kern 1,700 42.8
Tulare 479 21.7
Kings 133 17.4
San Luis Obispo 170 11.5
Merced 110 8.7
Fresno 350 7.3
Ventura 311 6.9
San Joaquin 193 5.7
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Incidence of hospitalized coccidioidomycosis by
race and county, 1997-2002
Incidence of hospitalization (crude per 100,000) RR of hospitalization Kern, Kings, Tulare and San Luis Obispo Counties Kern, Kings, Tulare and San Luis Obispo Counties
Incidence of hospitalization (crude per 100,000) RR of hospitalization Incidence of hospitalization RR of hospitalization
White 3.6 Ref 26.6 Ref
Hispanic 3.4 0.73 (0.68-0.78) 24.1 0.71 (0.63-0.79)
Black 8.0 2.68 (2.48-2.91) 80.8 2.43 (2.10-2.82)
Native American 1.4 0.32 (0.21-0.51) 12.7 0.37 (0.20-0.70)
Asian 2.0 0.78 (0.70-0.87) 51.0 1.62 (1.34-1.97)
RR by multivariate Poisson model controlling for
year, county, age, race and gender
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Incidence of hospitalized coccidioidomycosis by
sex, diagnosis and county, 1997-2002
Incidence of hospitalization (crude per 100,000) RR of hospitalization Kern, Kings, Tulare and San Luis Obispo Counties Kern, Kings, Tulare and San Luis Obispo Counties
Incidence of hospitalization (crude per 100,000) RR of hospitalization Incidence of hospitalization RR of hospitalization
Female 2.3 Ref 21.9 Ref
Male 5.0 2.14 (2.03-2.27) 36.6 1.67 (1.53-1.85)
Pregnancy 3.8 2.5 (2.03-3.08)
AIDS 133.0 36.2 (32.5-40.3)
RR by multivariate Poisson model controlling for
year, county, age, race and gender
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Incidence of hospitalized coccidioidomycosis by
age group and county,1997-2002
Incidence of hospitalization (crude per 100,000) RR of hospitalization Kern, Kings, Tulare and San Luis Obispo Counties Kern, Kings, Tulare and San Luis Obispo Counties
Incidence of hospitalization (crude per 100,000) RR of hospitalization Incidence of hospitalization RR of hospitalization
0-14 years 0.5 0.12 (0.10-0.14) 3.9 0.12 (0.09-0.15)
15-49 years 3.5 Ref 31.3 Ref
50-69 years 7.1 2.13 (2.01-2.26) 57.2 1.83 (1.66-2.03)
70 years 7.3 2.74 (2.54-2.97) 102.7 1.83 (1.58-2.12)
RR by multivariate Poisson model controlling for
year, county, age, race and gender
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Valley Fever as a cause of community acquired
pneumonia (CAP)
Valdivia L, Nix D, Wright M, Lindberg E, Fagan T,
Lieberman D, Stoffer T, Ampel NM, Galgiani JN.
Emerg Infect Dis 2006 12958-62.
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Prospective Study of Valley Fever as a cause of
CAP

• Hypothesis
• One-quarter of all CAP in Southern Arizona are in
  fact due to Valley Fever.
• Study design
• Prospective, observational, non-interventional
  evaluation of Tucson residents seeking care for
  CAP.

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METHODS

• Study periods
• December 1, 2003 to February 21, 2004
• May 1, 2004 to August 14, 2004
• Sites of enrollment Tucson
• a primary care practice
• UMC urgent care clinic
• Inclusion Criteria
• Lower respiratory syndrome of lt 1 month duration
• Patients 18 or older
• Endemic residence for gt 1 week

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PROTOCOL

• Initial assessment
• Demographics and symptom inventory
• Fatigue and respiratory infection severity scales
  self-administered.
• Blood specimens for central serologic testing
• Repeat blood specimen at 2 weeks.
• Follow-up for seropositive patients

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Results

• Of 55 patients enrolled, 16 were serologically
  positive for Valley Fever
• 29 (CI 16 - 44)
• 46 (84) were prescribed antibacterial drugs
• Serology findings
• 14 subj. were either IDTP or IDCF positive
• 2 subj. were EIA IgG alone (no second specimen
  on either)
• 38 subjects were sero negative
• 27 did not have second specimen
• Median endemic exposure significantly shorter for
  sero-positive subjects (6 versus 10 years,
  p.027)
• No differences related to gender or age

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